Which of the following would the nurse expect to find in a newborn who is developing sepsis? Select one:
Hyperglycemia and increased appetite.
Increased urinary output and spitting up mucous.
Wakefulness and ruddy appearance.
Temperature instability and lethargy.
The Correct Answer is D
Choice A Reason: Hyperglycemia and increased appetite. This is an incorrect answer that describes symptoms of diabetes mellitus, not sepsis. Diabetes mellitus is a chronic metabolic disorder where the body cannot produce or use insulin effectively, which results in high blood glucose levels and impaired glucose tolerance. Diabetes mellitus can affect newborns if the mother has pre-existing or gestational diabetes, which can cause macrosomia, hypoglycemia, or congenital anomalies.
Choice B Reason: Increased urinary output and spitting up mucous. This is an incorrect answer that indicates normal or benign conditions, not sepsis. Increased urinary output is a normal finding in newborns, as they eliminate the excess fluid that was accumulated during pregnancy. Spitting up mucous is a common occurrence in newborns, as they clear their airways of amniotic fluid or secretions.
Choice C Reason: Wakefulness and ruddy appearance. This is an incorrect answer that suggests healthy or normal characteristics, not sepsis. Wakefulness is a sign of alertness and responsiveness in newborns, which reflects their neurological development and adaptation. Ruddy appearance is a reddish color of the skin that is normal in newborns, especially in term or post-term infants, which indicates adequate oxygenation and hemoglobin levels.
Choice D Reason: Temperature instability and lethargy. This is because temperature instability and lethargy are common signs of sepsis in newborns, which indicate systemic infection and inflammation. Sepsis is a life-threatening condition where the body's response to infection causes tissue damage, organ failure, or death. Sepsis can occur in newborns due to maternal, fetal, or neonatal factors, such as chorioamnionitis, premature rupture of membranes, prolonged labor, invasive procedures, or bacterial colonization.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason: "My baby will always be smaller than other babies his age." This is an incorrect answer that indicates a misconception or pessimism about SGA newborns. SGA newborns may not always be smaller than other babies their age, as they may catch up in growth and development with appropriate nutrition and care. SGA newborns may have different growth paterns depending on the cause and timing of their growth restriction.
Choice B Reason: "My baby will be okay as long as he has frequent feedings." This is an incorrect answer that indicates an oversimplification or optimism about SGA newborns. SGA newborns may not be okay with just frequent feedings, as they may have other problems or complications that require medical atention and intervention. SGA newborns may have increased nutritional needs and feeding difficulties due to low birth weight, poor suck-swallow coordination, or oral aversion.
Choice C Reason: "My baby will need to stay in the hospital until he weighs 5 pounds." This is an incorrect answer that indicates a misunderstanding or confusion about SGA newborns. SGA newborns may not need to stay in the hospital until they weigh 5 pounds, as they may be discharged earlier or later depending on their condition and readiness for home care. SGA newborns may have different criteria for discharge based on their gestational age, weight gain, feeding tolerance, temperature stability, and absence of complications.
Choice D Reason: "My baby can get cold easily, may have low blood sugar, and may have trouble breathing." This is because this statement by the parents indicates that they understand some of the common problems and complications that SGA newborns may face. SGA newborns are those who weigh less than the 10th percentile for their gestational age, which can be due to intrauterine growth restriction (IUGR) or constitutional factors. SGA newborns may have difficulties with thermoregulation, glucose metabolism, and respiratory function due to inadequate fat stores, glycogen reserves, and surfactant production.
Correct Answer is C
Explanation
Choice A Reason: Homans' sign. This is an incorrect answer that refers to a different sign that is not related to pregnancy. Homans' sign is a sign of deep vein thrombosis (DVT) that occurs when there is pain or discomfort in the calf or popliteal region when the foot is dorsiflexed. Homans' sign can be elicited by passive or active movement of the foot, but it is not a reliable or specific indicator of DVT.
Choice B Reason: Chadwick's sign. This is an incorrect answer that refers to a different sign of pregnancy that affects the color of the cervix, not the texture. Chadwick's sign is a sign of pregnancy that refers to the bluish or purplish discoloration of the cervix, vagina, and vulva due to increased blood flow and congestion. Chadwick's sign can be observed by visual inspection of the cervix during the first prenatal visit, usually around 6 to 8 weeks of gestation.
Choice C Reason: Goodell's sign. This is because Goodell's sign is a sign of pregnancy that refers to the softening of the cervix due to increased vascularity and edema. Goodell's sign can be detected by digital examination of the cervix during the first prenatal visit, usually around 6 to 8 weeks of gestation.
Choice D Reason: McDonald's sign. This is an incorrect answer that refers to a different sign of pregnancy that involves the angle of the uterus, not the cervix. McDonald's sign is a sign of pregnancy that refers to the ease of flexing the body of the uterus against the cervix, which creates an angle of 90 degrees or less. McDonald's sign can be assessed by bimanual examination of the uterus during the first prenatal visit, usually around 7 to 8 weeks of gestation.
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